Fetal anatomy with magnetic resonance imaging.
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Fetus↗
Biomedical subjects
S M McCarthy
Publications and source records attributed to S M McCarthy.
Clinical stage I endometrial carcinoma: pitfalls in preoperative assessment with MR imaging. Work in progress.
PURPOSE: To identify potential pitfalls in using magnetic resonance (MR) imaging to determine the depth of myometrial invasion in patients with clinical stage I endometrial carcinoma. MATERIALS AND METHODS: Forty women with clinical stage I endometrial carcinoma underwent preoperative pelvic MR imaging. Uterine length, tumor signal intensity, appearance of the junctional zone, presence of large polypoid tumors, leiomyomata, and congenital uterine anomalies were analyzed. Univariate logistic-regression analysis was performed to identify associations between incorrect MR staging and these variables. RESULTS: MR staging of IA, IB, and IC disease was 55% accurate (22 of 40 cases); MR differentiation of deep myometrial invasion (stage IC) from superficial disease (stages IA and IB) was 78% accurate (31 of 40 cases). Older age (P = .025), presence of polypoid tumors (P = .025), and difficulty in pathologic staging (P < .005) were significantly associated with incorrect MR assessment. CONCLUSION: When present, large polypoid tumors, leiomyomata, congenital anomalies, small uteri, and indistinct zonal anatomy may make it difficult to assess myometrial invasion at MR imaging.
Aged↗
Comprehensive care of the child with a chronic condition. Part 2. Primary care management.
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Acute Disease↗
Comprehensive care of the child with a chronic condition. Part 1. Understanding chronic conditions in childhood.
Understanding the care of children with chronic illnesses and disabilities is an important part of the practice of pediatrics. Children with special health care needs and their families benefit from the support which comprehensive, coordinated, accessible, and responsive services provide. Although the primary care pediatrician is often most appropriate to serve as the overall coordinator of such services, many challenges to providing such care exist. Part 2, "Primary Care Management," will suggest guiding principles and management structures that allow the pediatrician to respond most effectively over time to the needs of children with chronic conditions and their families.
Child↗
Cost effectiveness of magnetic resonance imaging of the knee.
When compared to diagnostic arthroscopy in patients with knee complaints consistent with internal derangement, MR imaging emerges as a cost effective diagnostic supplement to clinical examination. This article concludes that the results of MR imaging can be used as a guide for the management of knee pain.
Arthroscopy↗
Pelvic MR imaging findings in gestational trophoblastic disease, incomplete abortion, and ectopic pregnancy: are they specific?
Thirty-nine patients with abnormally elevated levels of serum beta subunit of human chorionic gonadotropin (beta-hCG) were studied to determine whether findings at magnetic resonance (MR) imaging are specific for primary molar disease, persistent gestational trophoblastic disease (GTD), incomplete abortion, and ectopic pregnancy. Among the latter three groups, the only significant differences were a higher prevalence of endometrial distention in the group with incomplete abortion (P < .0035) and the absence of junctional zone disruption in the group with ectopic pregnancy (P < .05). In the group with primary molar disease, total intrauterine volume was significantly increased (P < .001), and endometrial distention and presence of an endometrial mass had a significantly higher prevalence than that in the persistent GTD groups with (P < .04) or without (P < .001) metastases. Myometrial or extrauterine disease was identified in 65% of the patients with persistent disease and a beta-hCG level greater than 500 mIU/mL (500 IU/L). Thus, although MR imaging findings in persistent GTD, incomplete abortion, and ectopic pregnancy are relatively nonspecific, MR imaging can depict invasive disease that may alter therapeutic management in patients with documented GTD.
Abortion, Incomplete↗
Zonal anatomy of the cervix: correlation of MR imaging and histologic examination of hysterectomy specimens.
High-resolution magnetic resonance (MR) images of nine hysterectomy specimens were correlated with light microscopy, computer-aided image analysis, and immunohistochemical examination to investigate the histologic counterparts of the zonal anatomy of the cervix. A central stripe of high signal intensity, a surrounding middle layer of low signal intensity, and an outer layer of intermediate signal intensity were found in all specimens. Histologic correlation indicated that the central stripe most likely represents the secretions in the canal, the cervical mucosa, and the plicae palmatae; the other two layers represent fibromuscular stroma. The percentage of nuclear area in the inner zone of the fibromuscular stroma is 2.5 times greater than in the outer zone, which may account for the lower signal intensity of the inner zone. No difference in distribution of collagen, laminin, and fibronectin (common components of the extracellular matrix) was found between the two zones of the cervical fibromuscular stroma.
Adult↗
Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal sonography, and hysterosalpingography.
The purpose of this study was to compare the relative accuracy of magnetic resonance (MR) imaging (n = 26), endovaginal sonography (EVS) (n = 14), and hysterosalpingography (HSG) (n = 20) in the classification of müllerian duct anomalies in 26 patients. There were 24 cases of surgically proved anomaly, and two patients had normal uteri (one with a vaginal septum). MR imaging allowed diagnosis of 24 of 24 cases (accuracy, 100%), and EVS was correct in 11 of 12 cases (accuracy, 92%). HSG was correct in only four cases. In the diagnosis of septate uterus, MR imaging demonstrated a sensitivity and specificity of 100% and EVS demonstrated a sensitivity of 100% and a specificity of 80%. Both MR imaging and EVS demonstrated a sensitivity and specificity of 100% in distinguishing those anomalies that did not require surgery. The high accuracy of MR imaging and EVS permit noninvasive differentiation of uterine anomalies and can spare women diagnostic laparoscopy, promoting cost-effective diagnosis.
Congenital Abnormalities↗
Value of lipid- and water-suppression MR images in distinguishing between blood and lipid within ovarian masses.
The distinction between blood and lipid in ovarian masses on MR imaging is important in the differential diagnosis of these lesions. However, this is often difficult on routine MR images because both blood and lipid within tumors can have the same signal intensity as subcutaneous fat. Accordingly, we studied the value of lipid- and water-suppression MR images in making this distinction in 16 patients (21 lesions). As proved by surgery (six patients) or laparoscopy (10 patients), there were 16 endometriomas, one hemorrhagic leiomyosarcoma, and four lipid-containing mature cystic teratomas. The signal intensity in all 17 hemorrhagic lesions was greater than that of subcutaneous fat on lipid-suppression images and less than that of fat on water-suppression images. This compared with the signal intensity of the four lesions that contained lipid, in which the signal intensity was similar to that of subcutaneous fat on both the lipid- and water-suppression images. Thus, the lipid- and water-suppression MR images allowed an accurate distinction between the two. Our experience suggests that the appearance of blood and lipid in ovarian tumors is sufficiently different on lipid- and water-suppression MR images to allow an accurate distinction between the two. The two techniques should be useful in the differential diagnosis of such lesions by MR imaging.
Adipose Tissue↗
A case illustration of family management style.
Chronic illness management is a way of life for many children and their families. For these chronically ill children, the ability of the family to respond to the daily relentless demands of management dictates the quality of the child's and family's life. In an effort to better understand how a family responds to a chronic illness, Knafl and Deatrick's Family Management Style (FMS) model is applied to a family with a child with type I diabetes using a case-study analysis. Gallo derived dimensions of the model's components in an earlier application. These dimensions are applied to interview data obtained on the same family 1 year later to address the dynamic nature of family management style.
Adaptation, Psychological↗
An evaluation of MRI contrast in the uterus using synthetic imaging.
Using a 1.5-T system, we investigated the contrast in MR images of the uterus using a synthetic imaging program that was capable of producing images with TR values of 20 to 10220 ms and TE values of 1 to 511 ms. Synthetic images were calculated from images obtained on six normal women of reproductive age. The synthesized uterine images were essentially indistinguishable from acquired images with the same TR and TE parameters. Cervical and uterine anatomy could be clearly differentiated in synthetic images with a TE = 80 ms when the TR was as low as 100 ms. We conclude that the zonal anatomy of the uterus can be demonstrated using TR values that are much lower than those usually used for demonstrating uterine anatomy.
Cervix Uteri↗
Imaging of ovarian masses: magnetic resonance imaging.
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Dermoid Cyst↗
Junctional zone of the uterus: correlation of MR imaging and histologic examination of hysterectomy specimens.
High-resolution magnetic resonance (MR) images of 12 hysterectomy specimens were correlated with results of light microscopy, image analysis, and immunohistochemical studies to investigate the histologic counterpart of the low-signal-intensity band, or junctional zone (JZ), that surrounds the bright central uterine stripe. All specimens were imaged with a 1.5-T superconducting magnet within 21/2 hours (on average) after hysterectomy. Comparison of histologic findings with measurements obtained at MR imaging indicates that the JZ represents the innermost layer of the myometrium. A threefold increase in percentage of nuclear area was found in the JZ in comparison with the outer myometrium, reflecting an increase in both size and number of nuclei. No difference in distribution of common components of the extracellular space (collagen, laminin, and fibronectin) was found between the two layers.
Adult↗
Uterine changes after dilation and curettage: MR imaging findings.
To determine what, if any, changes occur in the appearance of the uterus on magnetic resonance (MR) images after dilation and curettage (D&C), nine women without endometrial abnormality underwent imaging before D&C and on day 2 and day 7 after D&C. On day 2, markedly hypointense curvilinear areas in the endometrial canal were noted on MR images in all patients (P = .0002). By day 7, these areas decreased in size in five (62%) and completely resolved in the rest (P = .022). There was no significant change in the width of the endometrial stripe or in the width or signal intensity of the junctional zone or myometrium after D&C. The junctional zone was focally disrupted in one patient who underwent D&C that was complicated by a uterine perforation. Therefore, curvilinear areas of low signal intensity (most likely representing clot) in the endometrial canal were visualized on MR images within 2 days of uncomplicated D&C and decreased in size or resolved over time. Significant widening of the endometrial stripe or disruption of the junctional zone was not observed after uncomplicated D&C.
Adult↗
Chemical shift artifact: dependence on shape and orientation of the lipid-water interface.
On magnetic resonance images, chemical shift artifact (CSA) can be seen at a planar lipid-water interface oriented within the plane of the phase-encoding and section-select directions (ie, perpendicular to the frequency-encoding direction). Phantoms and a clinical case were used to demonstrate that when a lipid-water interface is curvilinear (eg, spherical) or planar but not oriented along the section-select direction, CSA may be absent or diminished. This effect can be seen at interfaces of normal structures (kidneys, bladder) as well as at interfaces with pathologic lesions such as lipid-containing dermoids. Not only is this effect dependent on section thickness, field of view, matrix size, and receiver bandwidth, but it is also strongly dependent on the orientation of the interface with respect to the section-select direction. Knowledge of the factors that can alter CSA is important since it is used to distinguish lipid-containing from nonlipid-containing structures of similar signal intensities.
Adult↗
Pelvic masses in pregnancy: MR imaging.
The value of magnetic resonance (MR) imaging was assessed for 17 pregnant patients with sonograms suggestive of a pelvic mass. The MR imaging signal features improved lesion characterization in 47% (eight of 17) of cases, including two of four mature cystic teratomas of the ovary, three uterine fibroids, one solid ovarian tumor, one endometrioma, and a distended urinary bladder that had been mistaken for an ovarian cystic mass. Both MR imaging and sonography were accurate for the characterization of three ovarian cystadenomas and two simple ovarian cysts. On both MR images and sonograms, two simple ovarian cysts were incorrectly diagnosed as complex cystic masses and one teratoma was incorrectly diagnosed as a simple cyst. The origin of the pelvic mass (13 in the ovary, three in the uterus, and one distended urinary bladder) was accurately determined on 100% (17 of 17) of the MR images versus 71% (12 of 17) of the sonograms. In three cases, the results of MR imaging led to cancellation of surgery, which would have proceeded on the basis of the sonographic results alone. MR imaging is a valuable complement to sonography for preoperative evaluation of pelvic masses in pregnant patients.
Adolescent↗
Applications of magnetic resonance imaging to gynecology.
The advent of MRI has improved the ability of the diagnostic radiologist to provide useful clinical information to the practicing gynecologist. Although US remains the screening procedure of choice for evaluation of the uterus and adnexa because of its relative safety and low cost, MRI is now considered the next imaging step. In a woman with pelvic pain, MRI can accurately identify adenomyosis, enumerate and localize uterine fibroids, and provide more accurate identification of endometriosis and cystic teratomas of the ovary than US. Although MRI should not be used as a screening procedure for diagnosing endometrial or cervical carcinoma, it can aid in patient management by determining the extent of myometrial or cervical invasion by endometrial carcinoma and can be used to calculate tumor volume in patients with cervical carcinoma. Early studies suggest that MRI may be helpful in distinguishing between long-term radiation fibrosis and tumor recurrence in such patients. MRI findings may be highly indicative of the presence of ovarian malignancy, but the procedure adds little to CT or US findings. Nevertheless, MRI is superior in the localization of pelvic masses and is often indicated in clarifying the origin of a mass as uterine or ovarian.
Endometriosis↗
Brachial plexus: correlation of MR imaging with CT and pathologic findings.
Thirty-two patients with symptoms referable to the brachial plexus were evaluated with magnetic resonance (MR) imaging. Sixteen patients had undergone concurrent computed tomography (CT). MR imaging demonstrated normal findings in 16, 12 neoplasms, three cases of trauma, and one case of possible neural edema. Of the 16 patients with normal findings on MR images, eight had CT scans that were also normal. In one patient, MR images showed that the "mass" seen on CT was actually a tortuous blood vessel. In six of the 12 cases of neoplasm in which CT scans were available, MR imaging revealed more extensive disease. In the other six cases of tumor, MR imaging provided sufficient clinical information to obviate the need for CT or any other imaging modality. MR imaging provided definitive diagnoses in the three cases of trauma without further imaging. In one patient with paresthesia, MR imaging showed high signal intensity of the nerves on T2-weighted images, which was compatible with neural edema. A concurrent CT scan was normal.
Brachial Plexus↗